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1336814649 NPI number — THEODORE SU DPT

NPI Number: 1336814649
Health Care Provider/Practitioner: THEODORE SU DPT

Information about “1336814649” NPI (THEODORE SU DPT) exists in 1336814649 in HTML format HTML  |  1336814649 in plain Text format TXT  |  1336814649 in PDF (Portable Document Format) PDF  |  1336814649 in an XML format XML  formats.

NPI Number : 1336814649 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336814649",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SU",
    "FirstName": "THEODORE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1300 W SAM HOUSTON PKWY S STE 300",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77042-2453",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "877-234-8034",
    "MailingAddressFaxNumber": "713-430-4046",
    "FirstLinePracticeLocationAddress": "13425 SE 30TH ST STE 2C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BELLEVUE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98005-4450",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "425-800-4488",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/10/2021",
    "LastUpdateDate": "03/15/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "PT61382998",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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